Three-dimensional High-resolution Anorectal Manometry in Children With Non-retentive Fecal Incontinence

Abstract

Background/AimsThree-dimensional high-resolution anorectal manometry (3D-HRAM) is a precise tool to assess the function of the anorectum. Our aim is to evaluate children diagnosed with non-retentive fecal incontinence (NRFI) using 3D-HRAM. MethodsIn all children diagnosed with NRFI, manometric parameters and 3-dimensional reconstructions of the anal canal subdivided into 8 segments were recorded. All data were compared to raw data that were obtained from asymptomatic children, collected in our laboratory and published previously (C group). ResultsForty children (31 male; median age, 8 years; range, 5-17) were prospectively included in the study. Comparison of the NRFI group and C group revealed lower values of mean resting pressure (74.4 mmHg vs 89.2 mmHg, P < 0.001) and maximum squeeze pressure (182 mmHg vs 208.5 mmHg, P = 0.018) in the NRFI group. In the NRFI group, the thresholds of sensation, urge and discomfort (40 cm 3 , 70 cm 3 , and 140 cm 3 , respectively) were significantly higher than those in the C group (20 cm 3 , 30 cm 3 , and 85 cm 3 , respectively; P < 0.001). In the NRFI group, 62.5% presented a mean resting pressure above the fifth percentile, and 82.5% of patients presented a maximum squeeze pressure above the fifth percentile. The comparisons between segments obtained from these patients and those obtained from the C group revealed several segments with significantly decreased pressure values in the NRFI group. ConclusionsOur study demonstrated lower pressure parameters in children with NRFI. In patients with normal resting pressures, 3D-HRAM may reveal segments with decreased pressures, which may play a potential role in the pathomechanism of incontinence.

Post-Operative Anorectal Manometry in Children following Anorectal Malformation Repair: A Systematic Review

“…Studies utilized anorectal manometry to evaluate a range of aspects relating to the management of anorectal malformation patients. Anorectal manometry was performed to compare malformation types [ 14 , 15 , 16 , 17 , 18 , 19 ]; appraise operative techniques [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]; evaluate post-operative assessment modalities [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]; assess and/or prognosticate bowel function [ 45 , 56 , 57 , 58 , 59 , 60 ]; and investigate the pathophysiology [ 46 , 61 , 62 , 63 , 64 ] and management [ ...…”

“…Fluid-perfused (water, saline or not described) catheters were used by the majority. Other reported methods included balloon or microballoon [ 16 , 37 , 49 , 50 , 69 ], solid-state [ 25 ], and microtransducer [ 40 , 45 , 64 ]. High-resolution manometry was utilized in six studies [ 22 , 34 , 52 , 54 , 64 , 72 ].…”

“…Other reported methods included balloon or microballoon [ 16 , 37 , 49 , 50 , 69 ], solid-state [ 25 ], and microtransducer [ 40 , 45 , 64 ]. High-resolution manometry was utilized in six studies [ 22 , 34 , 52 , 54 , 64 , 72 ]. The number of sensors ranged from a single sensor region using the open tip method, to 256 sensors utilized to perform high-resolution anorectal manometry (HRAM) [ 52 , 64 , 72 ].…”

Non‐retentive faecal incontinence in children: Conventional therapy alone or combined electrical stimulation

“…In addition to functional aetiology of FI, it can be due to an organic source or acquired deformity such as anorectal malformations, anorectal trauma or nervous system disorder. 3,4 Children with NRFI have normal intestinal movements and regular faeces, rare abdominal pain, normal colon transit and no large diameter stools. 3 It is suggested that the most successful approach for management of NRFI is behavioural therapy.…”

“…Patients with FI who have no faecal retention are categorised as non‐retentive faecal incontinence (NRFI). In addition to functional aetiology of FI, it can be due to an organic source or acquired deformity such as anorectal malformations, anorectal trauma or nervous system disorder 3,4 . Children with NRFI have normal intestinal movements and regular faeces, rare abdominal pain, normal colon transit and no large diameter stools 3 .…”